Plné znění - 241/2006 Sb.

Xxxxxxxxxxxxx xxx xxx Xxxxxxxxxx xx Applications xxx xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx to Xxxxxxx xx Xxxxxxxx Xxxx xxxxxxxx xx Xxx Xx. 209/1997 Xxxx., on the xxxxxxxxx of xxxxxxxxx xxxxxxx to the xxxxxxx of xxxxxxxx xxxx and on xxxxxxxx xxxxxxx xxxxx xxxx, as amended

Dear Xxx/Xxxxx,

Xx apologise for xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx xx xxxx questionnaire xx xxxxxxxx for the xxxxx assessment of xxxx application xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant xx Act no. 209/1997. Xxxxx xxx xxx xxxx cooperation; xx is xxxxxx xxxxxxxxxxx.

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X. Xxxxxx xxxxxxx xxxx xx the xxxxxxxx xxxx of xxx xxxxxxxxx - x.x. the xxxxxx xx the xxxxxxxx xxx xxx xxx xxxxxxxx bodily xxxx, xx the xxxxxxxx xx a xxxxxx xxx xxx xxxx xx consequence xx xxx xxxxxxxx xxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Xxxx xx xxxxx:

4. Xxxxxxxxx address:

5. Xxxx xxxxxxxx xxxxxxx (should xx xxxxxx xxxx xxx xxxxxxxxx xxxxxxx, xxxx):

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx xxx xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx basis xx statutory xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx xxxxx xxxxxxxxxxx xx his/her xxxxxx) xx xx the xxxxx xx x xxxxx xx attorney, xxxxxx xxxx xx xxx data xx xxxx xxxxxxxxxxxxxx:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the xxxxxxxxxxx xx xxxxxx xx xxx applicant, xxxxxx xxxx submit x xxxxxxxx xxxxxxxxxxx xxx/xxx xx represent xxx xxxxxxxxx - a xxxx xx x xxxxx xx xxxxxxxx (xxx contractual representation) xx a xxxx xx the birth xxxxxxxxxxx (for statutory xxxxxxxxxxxxxx) xx any xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x survivor xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx xxx respective criminal xxx, please fill xx the xxxxxxxx xxxx of xxx xxxxxxxx:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx xxxxx:

4. Xxxx xx xxxxx:

5. Last permanent xxxxxxx:

6. Xxxxxxxxxxx:

7. Relationship xx xxx deceased xx xxx xxxxxxxxx (x.x. xxxxxx, xxxxxxxx, xx xxxxxxxxxx xxxxxx xx xxxxxx household)

If xxx applicant xx x xxxxxxxx xx x xxxxxx xxx xxxx xx consequence xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx xxxxx xxxxxxxxxxx xxx any xxxxxxxxx xxxxxxx xxxx xxx xxxxxxxx supported xx xxx xx obligation xx xxxxxxx xxx xxxxxxxx (xx xxx xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx obligation xx xxxxxxx xxx dependent; xx xxx xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx a xxxxxxxx certificate).

Xxxxxx specify the xxxx xx xxxxx xxx crime xxx xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx xxx xxxxxxxxxxxx xx the xxxxx xx a later xxxx, xxxxxx xxxx xxxxxxx the xxxx xxx the xxxxxx xx which xxx xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx (e.g., xxx xxxx xx xxx xxxxxxx report).

VI. Xxxxxx xxxxxxx xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, public xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx criminal xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx of xxx xxxx xxxxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx xxx abovementioned xxxxxxxx justice xxxxxxxxx xxxxx could xxxxxxxx xxx stage xx xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx prosecution, copy xx xxx indictment, xxxxxxxxx - xxxxx xx otherwise).

According xx xxx xxxxxxxxxx xx §8 xx Xxx no. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx xxx xx reduced or xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx xxxx use xx all xxxxx xxxxxxxx xx xxxxxxx x claim xxx xxxxxxxxxxxx xxxxxxx xxx xxxxxxxx xx any xxxxx xxxxxx xxxxxxxxxxx xxx xxx harm xxxxxxxx. Xx not xxxx xx xxxx xxxx xx xxx xxxxxxxx xxx xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx applicant xx x xxxxxxxx xx xx individual who xxx died in xxxxxxxxxxx xx xxx xxxxxxxxx xxxxx.

1. Xxx you x xxxxx, xxxxxx xx xxxxx xx xxx xxxxxx who xxxx xx consequence xx xxx criminal xxxxxxx?

2. Xxx xxx xxxx xx a common xxxxxxxxx xxxx the xxxxxxxx xxxxxx xxxxx xx xxx xxxxxxxxxx xx xxx xxxxx?

3. Xxxx xxx x xxxxxxxxx xx xxx xxxxxx xx xxx xxx deceased obliged xx xxxxxxx you?

4. Xx xxx xxxxx xxxxxxx xxxx xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Please give xxxxx xxxxxx, xx xxxxx to you.

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According xx xxx xxxxxxxxxx xx §2, section 2 xx Xxx xx. 209/1997, a xxxxxx xxx xx x survivor of x victim xxx xxxx xx xxxxxxxxxxx xx x xxxxxxxx xxx xx xxxxxxxxxx xx xx x xxxxxx xx xx xx xxx xx x parent, xxxxxx xx xxxxx xx xxx xxxxxxxx xxx xxxxx xxxx him xx xxx xx xxx xxxx xxxxxxxxx xx xx the xxxxxx xxx x xxxxxxxxx xx the xxxxxxxx xx xxx xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx the applicant xx the xxxxxx xx x crime xxx has xxxxxxxx xxxxxx harm, xxxxxx xxxx in xxxxx XX - XXX.

Please xxxxxx x point-based xxxxxxxxxx xx pain xxx xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx xxxxxx xx xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx contain x xxxxx-xxxxx xxxxxxxxxx xx xxx pam suffered xxx a xxxxx-xxxxx xxxxxxxxxx of xxx xxxxxxxx of xxx xxxxxx'x social xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx xxxx xxx xxxxx-xxxxx assessment xx the xxx xxxxxxxx xx relevant xxx the purposes xx Xxx xx. 209/1997. According xx xxx xxxxxxxxxx xx §6, xxxxxxx 2 xx Act xx. 209/1997, xx xxxxxxxxx xxxxxxx xxxx xx xxxxxxxx unless xxx xxxxx assessment xx xxx pain xxxxxxxx xx at xxxxx 100 xxxxxx.

The xxxxxx xxx xxxxxx xxxx xxx financial xxxxxxx xx the xxxxxx xx XXX 25,000 or xx xxxxxx equal to xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxx xxx xxxx xxxxxx (§7, xxxxxxx 1, xxxxxx x xx Xxx No. 209/1997 Xxxx.). lf xxx xxxxxx to xxxxx xxx x lump xxx xxxxxxx, xxxxx xx xx xxxx xx fill in xxxxx XXX - XxX.

This xxxxxxxx xxx xxxxxxxx xxx xxxxxxxxxx, xxxxxxxx equipment, xxxxxxxxxxxxxx xxxxx, xxxxxx xx xxxxxxxxx to xxxx xxx xx xxx home xx xxxx xxxxxxx treatment, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx not xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx xxxx xxxxxxxx xxx not xxxxxx xx xxxxxxxxxxx evidence, xxx Ministry xx Xxxxxxx xxx xxx xxxx xxxx into xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx xxxxxxxxx xxxxxxxxxx xxxx facts xx xxx application.

If xxx xxxxxxxxx xx an xxxxxxxx, xxxxx xxxxxxxxx xxxxx xxxxxxx a xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx the xxxxxxx xxxxxx xxxxxxxxx xx §351 et. xxx. xx Xxx xx. 262/2006, the Xxxxx Xxxxxx Code, xx xxxxxxx. lf xxx xxxxxxxxx xx xxxx-xxxxxxxx, such document xxxxx xx x xxxx of his/her xxxx xxxxxx tax xxxxxx. xx xxx xxxxxxxxx xx a xxxxxxx person xxx xx xxxx xx xxxxx his/her impaired xxxxxx xxxxxxxx, please xxxxxx x xxxxxxxx xxxxxxxxxx the xxxxxx xx xxx xxxxxxxxxx xxxxxxx. xx xxx xxx reason the xxxxxxxxx'x income xxxxxxxxx xxxxxx xx proven, xx exceptional xxxxx xx affidavit xxx xx attached.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx xx xxx criminal act xx xxxxx I xxx a xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx the xxxx 1 xxxx xxxxxxxx xx x xxxxxx xx xxx criminal xxx.

X xxxxxx xxxxxx xxxx I xxxx xxx lodged xxx xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx for xxxxxxxxxxxx xxx the xxxx xxxxxxxx as x xxxxxx xx xxx xxxxxxxx xxx xx xxx country xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx xx §12 of Xxx Xx. 209/1997 Xxxx., xx xxx provision xx financial support xxx the xxxxxxx xx xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx acts, xx xxxxxxx, X xx obliged xx xxxxxxxxx xxx Ministry xx Xxxxxxx xxx xxxxxx xxxxxxxx xx xxxxxxxxxxxx xxx xxx xxxx suffered, xx xx xxx xxxxxx xx the xxxxxxxxx xxxxxxx, within xxxx xxxxx xxxx xxx xxxx xx receiving xxx xxxxxxx xxxxxxx. X also xxxxxxxxxxx xxxx, xxxxx xxx xxxxx xx the xxxx-xxxx xxxxxx, X xxx file xx xxxxxxxxxxx xxxxxx the Xxxxxxxx of Justice xx xxxxx xxx xxxxx'x claim xxx xxx xxxxxx xx xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx xxxxxxxx, xxx xxxxx xxxxxx of xxxx xxxxxxxx and xxx xxxxxx of xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx information or xxxxxxxxxxx xxxxxxxxxxx for xxx xxxxxxxx xx xxxxxxxxxxxxx gaining benefits xxx xxxxxxxxx an xxxxxxx xxxxxxxx xx §21, section 1, xxxxxx c) xx Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx of xxx xxxxxxxxx xx xxx/xxx xxxxxxxxxxxxxx

- Upon xxxxxxx of xxx xxxxxxxxxxx for xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx pursuant to Xxx No. 209/1997, xxx Xxxxxxxx of Xxxxxxx xxxxx xxxxxxx xxxxxxx and xxxxxx xx x xxxxxx xxxxxx. Subsequently, xxx Xxxxxxxx xxxxx xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx xxx xxxx. Xxxxxx xxxxx xxxxxx xxxx xxx xxxx xx xxx xxxxxxx xx xxx xxxxxxxxxxx and xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall xxxxxx xxxxxxx xxx xxxxxxx xx xxxxxx xxx xxxxxxxxx xx xxx xxxxxxx xxx such xxxxxxx has been xxxxxxxx.

- The applicant xxxxx be xxxxxxxxxx x xxxxxx as xxx Xxx Xx. 209/1997 Xxxx. xxxx xx he/she xxx xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx commitment xx x crime. X xxxxxxxxx xxx xxx xxx xxxx xxxxxxxxx for the xxxxxx'x xxxxxxx of xxxxxxxx support xxxxx xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx xx xxx xxx xxxxxxxx (xxx xxx weakening xx xxxxxx position), xxxxx xxxx be at xxxxx 100 xxxxxx. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx in xxxxxxxxxxx xx a xxxxx xxxxx be considered xx be x xxxxxx xx the xxxxxxxx is x xxxxxx, spouse xx xxxxx xx the xxxxxxxx xxx the xxxxxxxx shared x xxxxxxxxx with xxx xxxxxxxx at xxx xxxx xx his/her xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx xxx required xx xxxxxxx the xxxxxxxx.

- Xxx No. 209/1997 Coll. on xxx provision of xxxxxxxxx xxxxxxx xx xxxxxxx xx xxxxxxxx xxxx xxxxxxxxxx x xxxxxxxxxx term of 1 year from xxx xxxx on xxxxx xxx xxxxxx xxxxxxx xx the xxxx xxxxxx xx xxx crime. Xx xxxx date does xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx xxxxx, the xxxxxx shall xxxxxxx xxxxxxxx of xxx xxxx xx xxxxx xx/xxx learned of xxx xxxxxxxxxxxx. The Xxxxxxxx xx Justice xxxxxx xxxx an xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xxxxxxx xxxxx the xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx support xx applied for xx x xxxxxx xxx xxx xxxxxxxx xxxxxx xxxx as x xxxxxx xx xxx xxxxxxxxxx xx x crime may xx in the xxxx xx a xxxx xxx xxxxxxxxx xx XXX 25,000 xx an xxxxxx xxxxx xx xxxx xxxxxx xx the xxxxx of xxxxxxx xxxxxxxxx as xxxxxx xx xxx xxxxxx, xxxxxxx by xxx xxxxxx previously paid xx xxx xxxxxx xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx. Xxx xxxxx amount xx xxxx xxxxxxx xxxx xxx xxxxxx XXX 150,000. If, xxxxx xxx xxxxxxxxx xx support, xxx xxxxxx proves xxxx xxx xxxx xxxxxxxx xxxxxxx the amount xxxxxxxx, xxx xxxxxx xxx receive xxxxxxxxxx xxxxxxx xx to xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx the xxxxxxxxxxxxxx period of xxxx (i.e., 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx xxx xxxx xxxxxx xx xxx xxxxx); in xxxx xxxx, xxx amounts xxxxxxx paid xxxx xx xxxxx xxxx xxxxxxx.

- An xxxxxxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxx xxxx xx a xxxxxx of xxx xxxxxxxxxx xx a xxxxx (a xxxxxx, xxxxxx xx xxxxx xx xxx deceased xxxxxx in a xxxxxx household xxxx xxx deceased xx xxx xxxx of xxx/xxx death xx xxxxxxxxx xx or xxxxxxxx xx xx xxxxxxxxx by the xxxxxxxx) xxxxx xx xxxxxxxx xxxx a xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx xxxxx amount xxxxxxxx as xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx xxx xxxxxx xx xxxxxxx xxxxxx xxxxx, xxx amount xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xxxx xxx replace xxx xxxxxxxxx of the xxxxxxxxx liability xx xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx xxxxxxx xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should xxxx xx xxxxxxxx to xxx xxxxxxxx xxxxxxxxx xxxx liability xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, in xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx application xxx the xxxxxxxxx xx financial xxxxxxx xx xxxxx xxxx xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx xxxx xx mind that xxx xxxxxxxxx documents xxx xxxxxxxxxxxxx required xxx xxx respective xxxxx xxxx xx xxxxxxxx xx the xxxxxxxxxxx. Xx the xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx applicant xxxx xx deliver xxx xxxx xxxxxxxxx and xxxxxxxxxxxxx even xxxxxx x supplementary deadline, xxxx xxxx xxx xxxxxxx a xxxxxxxx xx xxxxxxxx xxx xxxxxxx as per Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, however, xxxxxxxxx xxx xxxxxx xx xxxxxxx application.

- Xxxxxx xxxx xx xxxx xxxx xxx xxxxxxxxx xxxxx be obliged xx return xxx xxxxxxxxx amount received xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx the xxxxxxx xx xxx Xxxxxxxx xx Xxxxxxx up xx xxx amount xx the xxxxxxx xxxxxxxx. This xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx xxx xxx received any xxxxxxxxxxxx. Xx so xxxxxxxxx xx the xxxxxx xx xx xxxxxxxxxxx, xxx Xxxxxxxx xx Justice xxx xxxxx xxx xxxxx'x xxxxx to xxxxx xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx xxxxx xxx xxxxx xx xxx xxxx-xxxx xxxx, xxxxxxxx xxxx a waiver xx justified xx xxx xxxxxx'x social xxxxxxxx, the xxxxx xxxxxx xx the xxxx xxxxxxxx and xxx xxxxxx xx xxxxxxxxxxxx xxxx to xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, xxx xxxxxx Xxx xxxxxxxxx xxxxxxxxxxxx otázkami. X xxxxxx xxxxxxxx xxxxxxxxx Xxxxx žiadosti x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej činnosti xxxľx xxxxxx č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, ktorú si xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx čitateľne osobné xxxxx x xxxxxxxľxxx - obeti trestného xxxx, ktorej xxôxxxxxx xxxx na zdraví, xxxxx xxxxx pozostalej xx osobe, xxxxx x dôsledku xxxxxxxxx xxxx zomrela:

1. Xxxxxxxxxx:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx adresa (x xxxxxxx, že xx xxxx xx xxxxxx xxxxxxxx xxxxxxxx):

6. Telefón:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Xx xxxxxxxľx xxxxxxxxx xxx xxxxx (zástupca) xx xxxxxxx xxxxxxxxx xxxxxxxxxx (xxxx. xxxxxxxx dieťa xxxxxx xxxxxxx) alebo xx xxxxxxx dohody x xxxxx xxxx, xxxxxxx xxxxx x xxxxxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxxxxxxxxxxx adresa:

Ak xxxxxxx xx inú xxxxx, xxxx xx xxxxxxx xxxxxxxxxx, xxxxx zastúpenie xxxxxxx. Xxxxx x xxxxxxxx xxxxxxxx xxxxx xxxxx moci (xxx xxxxxxxx xxxxxxxxx) alebo xxxxx xxxxxxx listu (x prípade xxxxxxxxx xxxxxxxxxx) xxxxx xxx xxxxxxx listinu.

III. Xx xxxxxxxľ xxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx o xxxxxxx xxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxx xxxxxxxxx:

4. Xxxxx xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. X xxxx xxxxxx xxxx zomretá xxxxx v xôxxxxxx xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, xxxxx žijúca x spoločnej domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx xx osobe, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx xx xxxx xxxxxxxx xxxxx xxxxxxxx xxxxx a xxxxxxx, xxxxx dokladajú xxxxxxxxxx, xx xxxxxx xxxxx vyživovala xxxxxxxxx xxxxx xxxxx xxxx xxxxxxxxx xx vyživovať (xx xxxxxx rodič - dieťa pôjde x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx povinnosti, xxx manželov takou xxxxxxxx xxxx sobášny xxxx a pod.)

IV. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx pošty alebo xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Vášho účtu.

V. Xxxxxx xxxxx, xxxx xx xxxx dozvedela x xxxxx xxôxxxxxxx xxxxxxxx činom.

Uveďte xxxxx xxxxxxxxx xxxxxxxxx činu x ak xx xxxx x škode xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, uveďte xxxx x ako (xxxxxxxxx z xxxxxxxxx xxxxxx - dátum xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx v xxxxxxxx konaní (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), xxxxx xxxxxxxxx xxxxx konanie o xxxxxxxx xxxx. Uveďte xx xxxxxxx značku, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx posledné xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx o xxx, v xxxx xxxxxx sa xxx xxxxxxxx (napr. xxxxxxxxx x xxxxxxxx trestného xxxxxxxx, opis xxxxxxxx, xxxxxxxx - x xxxxxxxxxxxxx), pripojte ho x xxxxxxxx.

XXX. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx nárok na xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona x. 209/1997 (Xx)., xxxxxxxx xxxxx xx xôxx xxxxxx xxxxx xx xxxxxxxx x prihliadnutím xx to, xx xxxx xxxxxxx xxxxxx xxxxxxx prostriedky xx xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx. Tento xxx nevyplňujte, ak xxxxxxxľx xxxxxxxxx xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ xx xxxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx činu xxxxxxx.

XXXX. Xxxxxx, xx xxx xxxxxxx xxxxxx, xxxxx xxľxx xxxxxxxxx xxxxxxx x §2 xxxx. 2 zákona x. 209/1997 Zb., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx známe.

1. Boli xxx rodičom, manželom xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx v xôxxxxxx trestného xxxx?

2. Xxxx ste x xxxxxx xxxxxxxxx činu xxxx xxxxxxxxx xxxxxxxxx xxxx x xxxxxxxxx xxxxxxxxxx?

3. Poskytovala Xxx xxxx trestného xxxx xxxxxx, či bola x xxxx povinná?

4. Xxľxxxx xxxxx osoby xxxxxxxxxxx xxxxxxxxx 1 xx 3? Uveďte xxx počet, xx Xxx je známy.

Podľa xxxxxxxxxxx §2 odst. 2 zákona č. 209/1997 Xx. sa xx xxxx xxxxxxxx xxxxx xxxxxxxxx po xxxxx, ktorá x xôxxxxxx xxxxxxxxx činu xxxxxxx, xx xx xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx x čase xxxx smrti s xxx xxxx v xxxxxxxxxx xxxxx xxxxx, xxxxxx nebohý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx výživu.

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Body IX. xx XIV. Vyplňte, xx xx xxxxxxxľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx xxxx xx zdraví.

IX. Uveďte xxxxx, xxxx xx xxxxxxxx xxxxxxxx, respektíve xxxx sa xxxxxxxx xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx ohodnotenia xx bolesť xxxx:

X xxxxxxxx sa xxxx xxxxxxxx bodové ohodnotenie xx xxxxxx podľa xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx od xxxxxx, xxxxx ho xxxxxxxxx. Xxxxx lekársky xxxxxxx xxxx obsahovať xxxxxx hodnotenie xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, že xxx účely zákona č. 209/1997 Zb. xx relevantné xxx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti. Podľa xxxxxxxxxxx §6 odst. 2 zákona x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx pomoc, xx bodové xxxxxxxxxxx xxxxxxxxx xxxxxxx nedosiahne xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx xxxxxxx x poskytnutie peňažnej xxxxxx vo xxxxx xxxxxxxxx xxxxxxx 25 000.- Xx alebo či xxxxxxxx xxxxx xxxxxx xxxxxxx a xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) zákona x. 209/1997 Xx. xx xxxxxxx xxxxx xxxxx poskytnúť peňažnú xxxxx vo xxxxx xxxxxxxxx sumy 25&xxxx;000.- Xx, xxxxx xx xxxxx xxxxxxxxxxxxxx preukázaným xxxxxxxx xx xxxxxxxx x xxxxxx xxxxxxx. Xx xx xxxxxxxxxx xxxxxx x xxxxxxx xxxxx xx xxxxx xxxxxxxxx čiastky, xxxxxxxx xx xxxxxxxxx body XXX. - XIV. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x xxxxxxxx xxxxxx:

Xxx x xxxxxxx xx xxxxx, zdravotnícke xxxôxxx, xxxxxxx na xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx xxxxx x xxxxxxxxxx či xxxxxxxxxx, xxxxxxx náklady xx xxxxxxx, x xxx. pod xxxxxxxxxx, xx tieto náklady xxxxxxxxx pojsťovňa. Xx xxxxxxx xxxxxxx sa xxxxx doložiť, xxxx xx ne xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx mócť xxxx zreteľ.

XIII. Popište xxxxxxxxx pomery xxxxxxxľx xxxx a xx xxxxxx xxxx xx xxxxxx xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, ktoré potvrdzujú xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx xxxxxx, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx x priemernom xxxxxxx xxxľx §351 x nasl. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, x xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, takou xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx xxxxxxxx priznania. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx situáciu, xxxx potvrdenie x xxxxx starobného xôxxxxxx. X xxxxxxx, xx x xxxxxxxx závažného xôxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxx žiadateľa, x xxxxxxx xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx xôxxxxxx) a xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx po vzniku xxxx na xxxxxx, xxôxxxxxxx xxxxxxxx činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X xxxxxxx, xx x dôsledku xxxxx xx zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx priznali xxxxxxxxx xôxxxxxx, xxxxxx x xxxxxxx xxxx výšku.

Xxxx majetkové xxxxxx xx xxxx, xx xxxxxxxx činom, xxxxxxx xxx xxx(x) xxxxxx, xx xxxx sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx xx xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx vyhlasujem, xx xxxxx xx xxxxxxx xxxxx xx obdobný xxxxx na xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom inom xxxxx xxx x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx vedomie, xx xx xxxľx xxx. §12 zákona č. 209/1997 Xx., x xxxxxxxxxx xxxxxxxx pomoci xxxxxxx xxxxxxxx xxxxxxxx x o xxxxx x x xxxxxxxx xxxxxxxxxx xxxxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx odo xxx, xxx xx xxxxxxxx xxxxx, odviesť xx xxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, a xx xx xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x xxx xxxxxx xx xxxxxxx, xx po xxxxxxxx xxxxxxxxxx päťročnej xxxx xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, xxx sa x xxxx xxxxx xxxxxx práva na xxxxxxxx poskytnutej xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxx xxxx xxxxxx xxôxxxxxxxx, xxxxxxx xxxxx xxxxx, xxxxx xx xxôxxxxxx x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, že xxxxxxxxx uvedením nesprávneho xxxxx neúplného xxxxx xx xxxx xxxxxxxxx xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx dopustiť priestupku xxxľx §21 xxxx. 1 xxxx. c) xxxxxx č. 200/1990 Xx., x priestupkoch, x xxxxx xxxxxxxxxx xxxxxxxxx.

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xxxxxx xxxxxxxľx xxxxx xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx republiky xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx zákona č. 209/1997 Zb. xxxxxxx jej príjem x udelí poradové xxxxx. Xxxxx xxxx xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx orgáne xxxľx xxxxxxxxxxx okolností prípadu. Xx xxxxx xxxxxxxx xx xxxxxx xxxxxxxx x predložení xxxxxxxxxx xxxxxxxx xxx xxxxx xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx xôxxxx, xxxxx xxxxx xxxxxxx poskynúť.

- X zmysle xxxxxx č. 209/1997 Zb. bude xxxxxxxľ xxxxxxxxxx xx xxxx xxx x xxxxxxx, xx mu v xôxxxxxx xxxxxxxxx xxxx xxxx spôsobené poškodenie xxxxxxx. Xxxxxxxxxxx, nie xxxx xxxxxxxxxxxx xxxxxxxxxx xx priznanie xxxxxxxx xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx bolesti (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho aspoň 100 xxxxx. Xx xxxx sa xxxxxxxx xx osoba xxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, ak xxxx xxxxxxx, manželom xxxxx dieťaťom zomretého x xxxxxxx v xxxx xxxx xxxxx x xxx žila x domácnosti, alebo xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo bol xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej pomoci xxxxxxx trestnej činnosti xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, keď xx obeť dozvedela x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Ak xxxxx xxxx xx xxx xx xxx xxxxxxxxx xxxxxxxxx xxxx, xxxx xxxxxxxx okamžik, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x poskytnutie xxxxxxxx xxxxxx, xxxxx xx xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx xx xxxxxxx xxxxx, xxxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx na xxxxxx, xxxxxxxx x xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, xxxxxxxxxx xxxxxxx xxxxxxx s xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx z xxxxxx xxxxxxx xxxxx xx xxxxxxx; xxxxx vo xxxxxx xxxxx nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - xx xxx, xxx jej xxxxxxxx xxxxx - preukáže, xx xxx vzniknutá xxxxx xx vyššia xxx xx, xxxxx xxxx podkladom xx xxxxxxxxxxx pomoci, na xxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx xxxxx xxxxxxxxx pomoc opäť, x xx xx xx xxxxxxxxxx výšky 150&xxxx;000.- Xx; xxxxxx xx prihliadne na xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, ktorá xx xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx (xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a zároveň x xxxx xxxx xxxxx s xxx xxxx x xxxxxxxxxx, xxxxx jej zomretý xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx xxxxxx), xx xxxxxxxx xxxxxxx xxxxx x xxxxxxxxx xxxx 150 000.- Kč; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Kč, x xx xx xxxxx obetí viac xxx tri xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx obeti xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx zodpovednosti xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, xx xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx je potrebné x záležitostiach dopravných xxxôx žiadať subjekt, xxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x celkom xxxxxxxxxxx xxxxxxxxx x prihliadnutím xx xxxxxxxxx výnimočné xxxxxxxxx xx možné xxxxxx xxxxxxxxxxxx spravodlivosti x poskytnutie xxxxxxxx xxxxxx.

- Xxxxxxxxxxx, xx xx xxxxxxxxxx priložiť xxxxxx xxxxxxxx xxxxxxx x xxxxxxxxxx, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx xxxxxxxxx. Ak xxx žiadateľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx žiadosť. Xx xxxxxx xxxxxxxxxx a xxxxxxx xxx xxxxxxxxx xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx zákona č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, že xx xxxx žiadateľovi xxxxxxxxxx peňažná xxxxx, xxxxxxxľ xx xx xxxxxxx rokov xxx xxx poskytnutia xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx sumy, xxxxx xxxxxx xxx xxxxxxx škody (xx xxxxxxxľx, poisťovne x xxx.) xx xx xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Xx xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x xxxx xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxxxx xxxxxx. Xx xxxxxx xxxxxx xxôxxxxxxx sociálna situácia xxxxx, xxxxxxx xxxxx xxxxx, xxxxx jej xxôxxxxxx, x xxxxx xxxxxxx, ktorú xxxx xxxxxxx.